Evaluation of dual trigger with gonadotropin-releasing hormone agonist and low-dose hCG in IVF outcome and in preventing OHSS for high ovarian responder in GnRH antagonist protocols

Abstract

Introduction: The traditional hCG trigger for initiating final oocyte maturation may increase the risk of OHSS in the patients with high response of hyperstimulation for IVF cycles using GnRH antagonist protocol. In contrast, GnRHa trigger alone can produce a short duration endogenous LH surge which is adequate to initiate oocyte maturation and can eliminate OHSS in these patients, however, it also decreases early corpora lutea which may decline the pregnancy rates. Therefore, an adequate luteal phase support is required to improve the IVF outcome. An another approach is dual trigger protocol which is a combination of GnRHa with low-dose hCG, is used to induce final oocyte maturation and minimize risk of OHSS while maintain functional corpus luteum. The aim of this study is to evaluate effects of dual trigger in IVF outcomes and in preventing OHSS in high responders to ovarian stimulation.

Methods: This RCT included 124 patients who were high responders to ovarian stimulation using GnRH antagonist protocol (had 10-18 follicles>14mm and E2 <5000 pg/mL on trigger day). 62 patients received a dual trigger (group A) and the others were given a dose of 5000 IU hCG for final oocyte maturation (group B). All patients at high risk of OHSS were excluded from the study.

Results: Number of MII, number of high quality embryo, clinical pregnancy rate and ongoing pregnancy rate were higher significantly in group A in comparison with group B (p<0.05). None of patients in group A developed OHSS while one patient was hospitalized with moderate OHSS in group B. One fresh transfer cycle was cancelled in group B due to high risk of developing OHSS.

Conclusion: Dual trigger may improve the IVF outcomes and be able to limit risk of OHSS in patients with high response of ovarian stimulation using GnRH antagonist protocol.